Infections Contracted in Hospitals Stir Concern

ATLANTA, Aug. 8—Hospital associated infections, often from germs that are difficult to treat, affect about 1.5‐million Americans each year, but much more information Is needed to cope fully with the problem, doctors said here at a week long international conference.

Surveys reported here in dicate that a wide variety of bacteria, viruses and fungi, many of which are resistant to commonly used drugs, infect about 5 per cent of the 30‐mil lion persons who are patients in the nation's 7,100 hospitals each year.

Hospital‐associated infection is the term applied to the dis eases produced by all these germs.

This category, said Dr. Alex ander D. Langmuir, the Public Health Service's retiring chief epidemiologist, is “perhaps the largest communicable disease problem in this country, one which will become worse be fore it gets better.”

While some doctors attend ing the conference at the Cen ter for Disease Control said they thought this broad gen eralization was somewhat un fair, because so many infections are lumped into the category, there was no disagreement about the significance of hos pital infections.

Almost all patients leave hospitals in better condition than when they entered. But infections can complicate and lengthen the stay of any pa tient—from a newborn infant to a person eligible for Medi care—in any hospital.

Further, they may cause a person to return several weeks later, as for example when a patient turns yellow from hepa titis after a blood transfusion or a mother gets a breast ab cess from her baby, who has acquired staph bacteria in the hospital nursery.

In many other cases, these infections represent diseases of medical progress. Some in fections result from techno logical innovations, such as when doctors insert tubes into veins, to feed patients; or wind pipes to help them breathe, or bladders, to drain their body fluid. Often these are geriatric patients whose lives have been extended by newer medical treatment but who can no longer cope with common types of infections with the same vigor that they did at a younger age.

Limitation on Drugs

Conference participants also said that such infections limitec the effectiveness of drug thera py of many cancer patients and the survival of recipients of surgically transplanted organs.

Because doctors do not have effective therapies against all such infections, because they are uncertain about the natura means of spread of some of these organisms. and because a variety of factors are respon. Bible for hospital‐associated in fections, they said that there was no simple solution to this national health problem.

They said that improved con trol required better detection and reporting of cases and measures to disinfect the hos pital environment more effec tively.

Surveillance for systematic correction, prompt analysis and quick dissemination of informa tion on the incidence of hospi tal infections is a service func tion that can help physicians control these illnesses in their hospitals, Dr. Langmuir said.

Because honest acknowledge ment of hospital‐associated in fections can cause legal and public relations headaches for hospital officials and physi cians, these institutions are often reluctant to comply with regulations and to report out breaks to health departments.

Full Admission Urged

Dr. Vincent F. Guinee of the New York City Health Depart ment said that many hospital administrators and doctors look upon the discovery of an outbreak in a hospital “as a visitation from an avenging god punishing them for their sins.”

“Though this May be the case,” he continued, “they can find help if they confess the outbreak to the hospital's epi demiologist” to curb these in fections.

Only relatively few hospitals have nurse or physician epi demiologists’ and conference participants urged that more do so.

Cleanliness remains the basis of preventing spread of infec tion, but no hospital can be perfectly designed to prevent cross‐infections from one pa tient to another, doctors said.

Hospitals are ideal places to spread infections, Dr. John F. Burke of the Shriners’ Burn In stitute in Boston said because patients harboring disease causing germs are concentrated with other noninfected patients who may be more susceptible than persons on the outside because they are already ill.

Patients are constantly bring ing to hospitals infections that they acquired in the communi ty. About 16 per cent of pa tients in community hospitals have active infections, a sur vey by the Center for Disease Control found, and two‐thirds of these people acquired their illness before admission.

Participants in this confer ence concentrated on the one third remaining, who became infected from a variety of sources while in hospitalS.

Many items “delivered to o? hospitals labeled ‘sterile’ are not, Dr. Carl W. Bruch of the Food and Drug Administration told a conference audience. If the food industry has developed methods to sterilize contents of cans, Dr. Bruch said, similar processes can be applied to hos pital supplies.

“Contamination of commer cial materials can be a health hazard,” he said, because the “sterilization” techniques used are inadequate to remove all microbial contamination.

Resource Shortage Cited

“F.D.A. has insufficient re sources and inadequate statu tory authority to regulate health hazards from medical levices and cosmetics.” he said, adding that such handi zaps prevented the agency from testing large quantities of such tems.

As a result, he said that the agency must rely !heavily on consumer complaints” to dc tect contamination of “sterile” products. Because hospitals are subject to these risks, Dr. Bruch said that some are taking on he added burden of culturing he “sterile” products they buy before permitting their use on patients.

Dr. Lars 0. Kallings of Stock holm said that drugs “contami sated during production in the )harmacies or pharmaceutical factories” could infect a patient in the hospital. Dr. Kallings de scribed an outbreak of dysen tery caused by salmonella bac teria that affected 200 Swedish patients who had swallowed contaminated thyroid pills im ported from the United States. He also said that bacterial‐con taminated eye ointments had caused some patients to lose their sight.

Physicians can also cause un suspected outbreaks of infec tion, it was reported. Dr. Carl Walter of Harvard Medical School told of an outbreak of 173 cases of pneumonia among 2,000 surgical patients over a five‐year period. He said the outbreak had been traced to an anesthetist who carried kleb siella bicteria on his fingernail.

Equipment, too, may be re sponsible for the infections, doctors said. Dr. Jay P. Sanford and Dr. Alan K. Pierce of the University of Texas Southwest ern Medical School at Dallas reported that they had linked cases of pneumonia, often caused by the hard‐to‐treat pseudomonas bacteria, with respiratory equipment.

Though environmental fac tors may be responsible for some hospital‐associated infec tions, many patients acquire ill nesses from micro‐organisms present on their own body. Either the disease or its therapy can weaken the patient's de fense system to the point where he succumbs to his own organ isms or to those that usually are not infectious for people who are well.

Doctors do not know exactly why one person can become infected, and another not, when both are exposed to the same disease‐producing organism. They are seeking clues in the white blood cells, which fight bacteria, and the immunologi cally important gamma globulin fraction of the blood serum because they have documented defects in these blood compo nents in patients who suffer rare diseases that produce fre quent infections.

Patients who receive trans planted organs are highly sus ceptible to infection, often with fungi and bacteria, because they are given drugs such as steroids to suppress the rejec tion phenomenon. High doses of steroidS also suppress the body's ability to fight infection.

Heart Transplant Deaths

Dr. Jack S. Remington re ported here that infection had killed five of 12 patients who died after receiving heart trans plants at Stanford Medical Cen ter in Palo Alto, Calif. These 12 patients had 41 separate in fections, he said, and “25 ‘per cent of our [20] heart trans plant cases had pneumonia due to a fungus called aspergilla, which rarely causes disease in the general population.”

Dr. Remington said that Mike Kasperak, who in 1968 was the first adult to receive a trans planted heart in this country, died of an aspergillosis absess in his transplanted heart.

Doctors are not certain whether patients acquire these organisms, or whether they carry them without symptoms for many years until the infec tion is activated by the stresses of these therapies.

Doctors do not know how often hospital visitors become infected. Physicians here men tioned an unusual event, which occurred earlier this year in West Germany, that illustrates this possibility. World Health Organization doctors reported that a man who had spent just a few minutes in a hospital there acquired smallpox from a patient whose physician had not yet diagnosed this conta gious viral disease.

The 30th anniversary this month of the key animal ex periments that led to penicil lin's use in humans proves that three decades of antibiotic use has not eradicated infections in or out of hospitals. Indeed, doctors here emphasized that misuse of the many antibiotics had created bacterial resistance to drugs and that when proper isolation techniques were not employed, these resistant or ganisms could spread from patient to patient in hospital. Despite the development of newer, more potent antibiotics, these micro‐organisms in our environment continue to outwit man.

Hospital‐associated infections are much less of a problem now than they were last century before doctors recognized that poor hygiene could spread puerperal sepsis among women after childbirth and before anti septics began to reduce the in cidence of surgical infections. But doctors at this conference recognized that elimination of the problem was not in sight.

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A version of this archives appears in print on August 9, 1970, on Page 42 of the New York edition with the headline: Infections Contracted in Hospitals Stir Concern. Order Reprints|Today's Paper|Subscribe